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Providing End-of-Life Comfort Through Massage  

Pain and palliative care massage therapy is becoming a standard part of caring for the critically ill and those nearing their end of their lives. Is this specialized massage practice right for you?

reassuring nurse holding patient hand
reassuring nurse holding patient hand
lisa schuetz

Written and Reported by Lisa Schuetz
Contributing Writer

Pain and palliative care massage therapy grew out of the needs of people who have a terminal illness such as cancer and are in hospice care. Many studies have indicated that massage in a palliative care setting can help reduce anxiety, pain, and depression in patients nearing the end of their lives.

The National Hospice and Palliative Care Organization strongly supports the use of massage as a therapy in hospice and palliative care, according to the organization’s spokesman, Jon Radulovic.

“It’s been used by programs for quite some time,” Radulovic says. “I think providers are learning more about the value of therapeutic touch to enhance the care they can provide to patients—and family caregivers too.”

The types of massage used in palliative care vary, but typically focus on gentler techniques.

“In terms of massage, all light touch modalities are useful in working with cancer patients,” says Susan Adler, a licensed massage therapist (LMT) who has worked for three years at the Perlmutter Cancer Center at New York University in New York City. “These include light Swedish relaxation massage, light shiatsu/acupressure, craniosacral therapy, manual lymphatic drainage, reiki, and reflexology.”

Yvette Quintana Pascal, massage therapy coordinator since 2018 at the Hospice Care Network on Long Island, New York, has been a licensed massage therapist for 20 years and has seen the comfort that such massage can bring to patients who are in pain or nearing the end of their lives.

“Bringing this energetic quality into this difficult time assists the family in processing all that they are feeling,” she says. “Just as birth is a sacred and blessed moment, this, too, is a sacred moment.”

Training and Education

As massage is increasingly viewed as a valuable component of complementary medicine for people with serious illnesses such as cancer, employers in healthcare settings are seeking licensed massage therapists who have completed additional training in oncology massage, says Adler. This means massage therapists may want to seek credentials beyond their basic massage training, or at least some hands-on experience.


woman massages elderly persons hand

In the U.S. and Canada, there is no national or state-level oversight of oncology or palliative care massage therapy, so there is no formal certification process.

Specialty certificates are offered by a number of organizations that train and education massage therapists, but having a certificate is voluntary and not mandated. Earning a certificate can, however, give a practitioner important knowledge about the specialized field of palliative care that may make them more marketable as they seek employment.

Various massage schools and training centers offer courses in hospice or palliative care massage. After completing an approved program, a massage student can take an exam to earn a specialty certificate through a number of organizations.

The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB), for example, offers the Pain and Palliative Care Massage certificate for massage therapists who provide services to individuals in hospice and hospital settings. The board also offers the Oncology Massage Specialty certificate for practitioners who work with patients with cancer.

This is the path Adler took. She added oncology massage training several years after completing her basic massage coursework and witnessing how beneficial touch was to a family member in hospice. “The training was extensive, incorporating not only practicing hands-on oncology massage techniques, but also learning about the broader challenges that cancer patients face, such as nutritional and psycho-social issues,” Adler says.

How Long Does It Take?

It depends on what type of program you take. If you’re just looking for a class to brush up on techniques, get ideas, or fulfill continuing education requirements to renew your massage therapy license, you can find one- or two-day courses that touch on certain aspects of pain and palliative care. If you’re interested in a more in-depth educational experience and looking to earn a certificate to demonstrate your knowledge, there are programs available that dive deep into dozens of related topics and last as long as a year.

What You’ll Learn in a Pain and Palliative Care Massage Program

There are a number of training programs that teach practitioners the fine points of working with patients seeking end-of-life comfort through massage. Classes in such programs range from basic first aid to specific techniques. While classes vary from school to school, you’ll likely cover topics such as:

  • Vibrational healing
  • How to approach scar tissue
  • Techniques to address lymphedema
  • Pediatric massage
  • Reflexology-based foot massage
  • Massage specifically designed for certain types of cancer, such as breast, brain, or neck
  • Hospital or clinic-based internship

Pascal began looking into how she could use her skills to help terminally ill and cancer patients in 2015, about 15 years into her career. It took her a year to complete an oncology massage course and receive her specialty certificate while still working full time. 

“A measure of self-study is imperative here,” Pascal says. “Know the stages of dying. Learn to recognize non-verbal communication. Always be respectful of families. And what I have found to be most important is to be fully present, grounded, calm, and supportive.”

At hospice centers, there are a fair number of cancer patients, she says, so she’s grateful for the oncology training that she’s had.

Adler adds that safety is an important consideration, which is something you learn in training.

“The therapist must be aware of the many ways someone with cancer may be more fragile than the general population, either from the disease itself, or from side effects of the treatment.”

Before You Sign Up …

Before you jump into specialty massage classes, make sure you do your homework. You should make sure the programs you’re interested in will train you specifically for your chosen practice. While hospice massage is often covered in palliative, pain and oncology massage courses, palliative and hospice massage training can differ.

Program Cost

The cost associated with earning an oncology or palliative care specialty certificate varies, depending on the type of classes you pursue and the school offering the classes. Keep in mind that you’ll pursue this specialty after you complete massage school and earn your massage therapy license. Massage school costs also depend on where you study and the specific classes you take.

The cost of speciality classes also depends on the depth of the program. Single classes that aren’t part of a full certificate program can be found through a variety of organizations, with costs dependent on the length of the class and the material covered. Full certificate programs with multiple classes, of course, cost more.  

The cost of a certification exam that proves your mastery of the subject matter, if not included in the program cost, typically hovers around $100. The NCBTMB’s specialty exam, for example, costs $95.

Job Opportunities

As a licensed massage therapist who specializes in palliative care massage for oncology patients or those seeking pain relief or comfort near the end of their lives, you will find a number of places looking for your expertise:

  • Cancer institutes
  • Hospice and home health agencies
  • Physical and occupational therapy clinics
  • Pain management clinics
  • Hospitals

Salary Opportunities

The U.S. Bureau of Labor Statistics (BLS) does not specifically track the salaries of pain and palliative care massage therapists, but it does list a massage therapist’s median annual salary. Use our salary tool to learn about massage therapist salaries in your state or anywhere in the U.S.

Massage Therapists

National data

Median Salary: $43,620

Bottom 10%: $22,580

Top 10%: $79,150

Projected job growth: 32.2%

State data

State Median Salary Bottom 10% Top 10%
Alabama $36,300 $18,550 $52,970
Alaska $82,600 $22,140 $132,950
Arizona $43,240 $26,740 $66,690
Arkansas $47,200 $25,210 $63,410
California $34,400 $27,230 $80,940
Colorado $46,020 $25,170 $65,170
Connecticut $42,460 $24,340 $81,100
District of Columbia N/A N/A N/A
Florida $36,360 $19,770 $66,090
Georgia $23,490 $16,770 $69,490
Hawaii $55,700 $25,330 $89,120
Idaho $44,860 $23,520 $78,050
Illinois $49,940 $20,450 $76,900
Indiana $44,780 $27,060 $72,470
Iowa $36,120 $20,290 $68,740
Kansas $29,210 $17,770 $80,830
Kentucky $49,930 $18,710 $75,440
Louisiana $23,890 $17,000 $57,630
Maine $53,430 $27,910 $87,240
Maryland $41,440 $23,140 $83,190
Massachusetts $61,790 $41,880 $112,470
Michigan $49,840 $23,570 $75,540
Minnesota $54,400 $22,680 $83,810
Mississippi $34,870 $17,570 $50,860
Missouri $37,080 $20,050 $67,500
Montana $40,070 $19,230 $68,250
Nebraska $57,390 $31,290 $79,390
Nevada $28,260 $18,000 $85,180
New Hampshire $49,590 $32,070 $83,930
New Jersey $45,490 $23,420 $68,620
New Mexico $46,050 $24,320 $83,750
New York $52,560 $27,200 $89,200
North Carolina $41,220 $19,150 $67,460
North Dakota $45,790 $18,300 $65,590
Ohio $48,000 $20,150 $79,750
Oklahoma $38,030 $20,950 $52,940
Oregon $61,220 $26,010 $96,720
Pennsylvania $41,620 $21,460 $85,640
Rhode Island $28,110 $23,370 $55,690
South Carolina $36,170 $18,110 $60,240
South Dakota $30,550 $22,430 $48,450
Tennessee $42,560 $18,940 $83,240
Texas $41,820 $21,560 $63,430
Utah $44,250 $18,550 $73,450
Vermont $38,730 $24,650 $77,510
Virginia $43,690 $18,780 $63,630
Washington $65,140 $40,480 $86,640
West Virginia $39,660 $20,620 $75,740
Wisconsin $48,190 $19,300 $68,730
Wyoming $49,760 $28,510 $76,090

Source: U.S. Bureau of Labor Statistics (BLS) 2020 median salary; projected job growth through 2030. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

Many factors could skew this number higher or lower, such as whether the therapist is:

  • Self-employed or working for a company
  • Working full time or part time
  • Paying for their own practice space

Training in the palliative care specialty could mean more job opportunities for practitioners, however, beyond their typical work in doctors’ offices, massage clinics, and within the recreational industry.

Career Outlook

According to the BLS, massage therapist careers are expected to grow much faster than average, at a rate of 21% through 2029.

Massage Therapist Job Growth Through 2029


much faster than average for all careers says the BLS.

The public’s increasing belief that holistic wellness, massage, and now stretching are methods that support longevity and health are behind the growth in massage therapy jobs over the next decade.

Is Pain or Palliate Care Massage the Right Specialty for You?

Adler says candidates must have the same qualities that work in a hospital setting: be compassionate and a team player.

“It is helpful to have a calm demeanor and to not get ruffled with repeated interruptions by other health care providers,” she says.

With professional insight from:

Jon Radulovic
Spokesman, National Hospice and Palliative Care Organization

Susan Adler
Licensed massage therapist

Yvette Quintana Pascal
Massage therapy coordinator, Hospice Care Network